There exists in academic medicine a core ethical issue that is seldom pursued: trainees are frequently not the best person in the operating room at a given intervention being performed, and yet as a profession we understand a fundamental need to afford them opportunities to perform. Academic centres are traditionally associated with a higher quality of care than non-academic centres, suggesting that practical measures exist within teaching hospitals that effectively mask the clinical discrepancies between trainees and their preceptors. Nonetheless, we (...) are bound by our ethical commitments as physicians to balance the obligations of care with the duty to teach. In order to ethically validate the model of ‘surgeon as teacher’, we propose that there must be a reconciliation of the tensions between traditional professional values in medicine with the constraints inherent in a time-bound utilitarian medical system. Ultimately, we must consciously accept that ensuring the longitudinal availability of skilled surgeons in society aligns more closely with our core ethical obligations as outlined in the social contract that medical professionals maintain with the general public than does the ethical demand to provide unreservedly individual-focused patient care. It is the duty of individual practitioners, as a necessity of lineage to maintain and fulfil our greater duties to society, to foster deontological relationships where possible within this utilitarian system while accepting short-term imperfection in our practice. There are no data in this manuscript. (shrink)

Emerging technologies such as artificial intelligence are actively revolutionizing the healthcare industry. While there is widespread concern that these advances will displace human practitioners within the healthcare sector, there are several tasks – including original and nuanced ethical decision making – that they cannot replace. Further, the implementation of artificial intelligence in clinical practice can be anticipated to drive the production of novel ethical tensions surrounding its use, even while eliminating some of the technical tasks which currently compete with ethical (...) deliberation for clinicians’ limited time. A new argument therefore arises to suggest that although these disruptive technologies will change the face of medicine, they may also foster a revival of several fundamental components inherent to the role of healthcare professionals, chiefly, the principal activities of moral philosophy. Accordingly, “machine medicine” presents a vital opportunity to reinvigorate the field of bioethics, rather than withdraw from it. (shrink)

Volume 20, Issue 8, August 2020, Page 51-53.

As Alfandre and colleagues describe in “Between Usual and Crisis Phases of a Public Health Emergency: The Mediating Role of Contingency Measures”, efforts to maintain standards of care durin...

In many jurisdictions, legal frameworks afford patients the opportunity to make prospective medical decisions or to create directives that contain a special provision forfeiting their own ability to object to those decisions at a future time point, should they lose decision‐making capacity. These agreements have been described with widely varying nomenclatures, including Ulysses Contracts, Odysseus Transfers, Psychiatric Advance Directives with Ulysses Clauses, and Powers of Attorney with Special Provisions. As a consequence of this terminological heterogeneity, it is challenging for healthcare (...) providers to understand the terms and uses of these agreements and for ethicists to engage with the nuances of clinical decision‐making with such unique provisions surrounding patient autonomy. In theory, prospective self‐binding agreements may safeguard patient's “authentic” wishes from future “inauthentic” changes of mind. In practice, it is unclear what may be comprised within these agreements or how—and to what effect—they are used. The primary focus of this integrative review is to curate the existing literature describing Ulysses Contracts (and analogous decisions) used in the clinical arena, in order to empirically synthesize their shared essence and provide insights into the traditional components of these agreements when used in practice, the requirements of their consent processes, and the outcomes of their utilization. (shrink)

Objective: To examine the role of explainability in machine learning for healthcare (MLHC), and its necessity and significance with respect to effective and ethical MLHC application. Study Design and Setting: This commentary engages with the growing and dynamic corpus of literature on the use of MLHC and artificial intelligence (AI) in medicine, which provide the context for a focused narrative review of arguments presented in favour of and opposition to explainability in MLHC. Results: We find that concerns regarding explainability are (...) not limited to MLHC, but rather extend to numerous well-validated treatment interventions as well as to human clinical judgment itself. We examine the role of evidence-based medicine in evaluating unexplainable treatments and technologies, and highlight the analogy between the concept of explainability in MLHC and the related concept of mechanistic reasoning in evidence-based medicine. Conclusion: Ultimately, we conclude that the value of explainability in MLHC is not intrinsic, but is instead instrumental to achieving greater imperatives such as performance and trust. We caution against the uncompromising pursuit of explainability, and advocate instead for the development of robust empirical methods to successfully evaluate increasingly inexplicable algorithmic systems. (shrink)

In their forthcoming article, ‘What makes a medical intervention invasive?’ De Marco, Simons, and colleagues explore the meaning and usage of the term ‘invasive’ in medical contexts. They describe a ‘Standard Account’, drawn from dictionary definitions, which defines invasiveness as ‘incision of the skin or insertion of an object into the body’. They then highlight cases wherein invasiveness is employed in a manner that is inconsistent with this account (eg, in describing psychotherapy) to argue that the term invasiveness is often (...) used to explicitly or implicitly reference interventions that do not fall under the standard account. The authors offer an alternative ‘schematic’ definition of invasiveness, whereby medical interventions entail an underlying context-independent property of ‘basic invasiveness’ and may be understood both relative to each other and to a context-specific threshold of what is ‘invasive’.1 We propose that the meaning of terms such as ‘invasiveness’ is necessarily heterogeneous, and that what is implied by its usage will certainly depend on context, particularly in medical settings. Hence, the creation of a unifying definition is less critical than clarification of the implied and intended meanings of each instance of the term’s use. We further argue that interpreting the use of terms like ‘invasiveness’ in medical practice is complicated by the embedding of each use of this term in a different ‘language game’, whereby words and their meanings are understood by an in-group familiar with …. (shrink)

Analgesia and amnesia represent two complimentary pillars of anesthesia directed, respectively, at mitigating the experience of pain and the processes of encoding that experience into memory. These elements are typically combined in modern anesthetic techniques, but some circumstances exist – such as conscious sedation – in which the conditions of amnesia are satisfied while analgesia plays an auxiliary and often incomplete role. These activities reflect a widely held yet underrecognized belief in clinical practice that although pain experiences may be short-lived, (...) their representation in memory and its subsequent effects on thought and emotion can have enduring consequences for patients. In this exploratory article, we delineate phenomenal and abstract ontological categories of pain experience; advance a claim that they are treated by analgesic and amnestic agents, respectively; and describe how each class of experience is uniquely able to bring about individual harm. Beginning with the question of how it can be permissible to allow any preventable experiences or memories of pain, we identify that both phenomenal and abstract pain manifest on a spectrum of severity, each with an enigmatic threshold – unique to circumstance and individual – that determines whether or not pain will translate into harm, and what permissions therefore surround its treatment. Ultimately, we find that there are compelling physiological reasons for the concurrent use of analgesics and amnestics when pain experience exceeds these thresholds, while the treatment of “sub-threshold” experience in either class is a purely ethical imperative to be balanced with considerations of the potential harms posed by the treatments themselves. (shrink)

In their forthcoming article, Shavelson and colleagues (2023) identify a key ethical concern associated with medical aid-in-dying (MAiD) laws in the eleven US jurisdictions where the practice is le...

BackgroundThe expectation of pandemic-induced severe resource shortages has prompted authorities to draft and update frameworks to guide clinical decision-making and patient triage. While these documents differ in scope, they share a utilitarian focus on the maximization of benefit. This utilitarian view necessarily marginalizes certain groups, in particular individuals with increased medical needs.Main bodyHere, we posit that engagement with the disability critique demands that we broaden our understandings of justice and fairness in clinical decision-making and patient triage. We propose the capabilities (...) theory, which recognizes that justice requires a range of positive capabilities/freedoms conducive to the achievement of meaningful life goals, as a means to do so. Informed by a disability rights critique of the clinical response to the pandemic, we offer direction for the construction of future clinical triage protocols which will avoid ableist biases by incorporating a broader apprehension of what it means to be human.ConclusionThe clinical pandemic response, codified across triage protocols, should embrace a form of justice which incorporates a vision of pluralistic human capabilities and a valuing of positive freedoms. (shrink)

Contemporary societies are often “polarized”, in the sense that sub-groups within these societies hold stably opposing beliefs, even when there is a fact of the matter. Extant models of polarization do not capture the idea that some beliefs are true and others false. Here we present a model, based on the network epistemology framework of Bala and Goyal, 784–811 1998), in which polarization emerges even though agents gather evidence about their beliefs, and true belief yields a pay-off advantage. As we (...) discuss, these results are especially relevant to polarization in scientific communities, for these reasons. The key mechanism that generates polarization involves treating evidence generated by other agents as uncertain when their beliefs are relatively different from one’s own. (shrink)

An expansive, yet succinct, analysis of the Philosophy of Religion – from metaphysics through theology. Organized into two sections, the text first examines truths concerning what is possible and what is necessary. These chapters lay the foundation for the book’s second part – the search for a metaphysical framework that permits the possibility of an ultimate explanation that is correct and complete. A cutting-edge scholarly work which engages with the traditional metaphysician’s quest for a true ultimate explanation of the most (...) general features of the world we inhabit Develops an original view concerning the epistemology and metaphysics of modality, or truths concerning what is possible or necessary Applies this framework to a re-examination of the cosmological argument for theism Defends a novel version of the Leibnizian cosmological argument. (shrink)

Twentieth-century analytic philosophy was dominated by positivist antimetaphysics and neo-Humean deflationary metaphysics, and the nature of explanation was reconceived in order to fit these agendas. Unsurprisingly, the explanatory value of theist was widely discredited. I argue that the long-overdue revival of moralized, broadly neo-Aristotelian metaphysics and an improved perspective on modal knowledge dramatically changes the landscape. In this enriched context, there is no sharp divide between physics and metaphysics, and the natural end of the theoretician’s quest for a unified explanation (...) of the universe is God, an absolutely necessary, transcendent, and personal source of all contingent reality. (shrink)

Why do minority groups tend to be discriminated against when it comes to situations of bargaining and resource division? In this paper, I explore an explanation for this disadvantage that appeals solely to the dynamics of social interaction between minority and majority groups---the cultural Red King effect. As I show, in agent-based models of bargaining between groups, the minority group will tend to get less as a direct result of the fact that they frequently interact with majority group members, while (...) majority group members meet them only rarely. This effect is strengthened by certain psychological phenomenon---risk aversion and in-group preference---is robust on network models, and is strengthened in cases where pre-existing norms are discriminatory. I will also discuss how this effect unifies previous results on the impacts of institutional memory on bargaining between groups. (shrink)

According to many philosophical theologians, God is metaphysically simple: there is no real distinction among His attributes or even between attribute and existence itself. Here, I consider only one argument against the simplicity thesis. Its proponents claim that simplicity is incompatible with God’s having created another world, since simplicity entails that God is unchanging across possible worlds. For, they argue, different acts of creation involve different willings, which are distinct intrinsic states. I show that this is mistaken, by sketching an (...) adequate account of reasons-guided activity that does not require distinct intrinsic states of willing corresponding to each possible act of creation. (shrink)

Given its centrality to the intellectual thought processes through which the great structures of logic, nature, and spirit are unfolded it is clear that mediation is vital to the very possibility of Hegel’s encyclopaedic philosophy. Yet Hegel gives little specific explanation of the concept of mediation. Surprisingly, it has been the subject of even less attention by scholars of Hegel. Nevertheless it is casually used in discussions of Hegel and post- Hegelian philosophy as though its meaning were simple and straightforward. (...) In these discussions mediation is the thesis that meanings are not atomic in that the independence of something is inseparable from its relation to something else. Hence being is mediated by nothing, the particular by the universal, the individual by society. But does Hegel ever explain mediation in a way which justifies such use of the concept? The same easy employment of mediation is found in Theodor Adorno whose works are replete with the use of this concept and, indeed, acknowledgements of its Hegelian origin. But the concept of mediation in Adorno’s negative dialectic is operative in an entirely different context from that of Hegel. How, it might be asked, can a concept be so adaptable? I want to argue that mediation is, in fact, an equivocal term which in both Hegel and Adorno covers a variety of entirely different conceptual relations. Furthermore, as propounded by both Hegel and Adorno it lacks the rigour which could allow the particular conclusions which the concept allegedly facilitates. (shrink)

Social media, meaning digital technologies and platforms such as blogs, wikis, forums, content aggregators, sharing sites, and social networks like Facebook and Twitter, have profoundly changed the way that information can be shared online. Now, almost anyone with a broadband internet connection or a smart phone can share ideas, data, and opinions with just about anyone else on the planet. This change has serious implications for the way in which human subjects research can be conducted and, concomitantly, for the ways (...) in which such research may be regulated. This article explores some of these issues. (shrink)

Social Media, like Facebook and Twitter, are having a profound effect on the way that human subjects research is being conducted. In light of the changes proposed in ANPRM, in this article I argue that traditional research ethics and regulations may not easily translate to the use of social media in human subjects research. Using the conceptual model of apomediation, which describes the peer-to-peer way in which health information is shared via social media, I suggest that we may need to (...) think again about the suitability of current regulations to deal with social media research. (shrink)

Many philosophers judge that typical agent-causal accounts of freedom improperly sacrifice the possibility of rational explanation of the action for the sake of securing control, while others judge that the reverse shortcoming plagues typical event causal accounts. (Of course, many philosophers make both these judgments.) After briefly rehearsing the reasons for these verdicts on the two traditional strategies, we undertake an extended examination of Randolph Clarke's recent attempt to meet the challenge by proposing an original, "integrated agent-causal" account of human (...) free action. We argue that Clarke's account fails. In a final section, we sketch a more promising route to integration. (shrink)

In his recent book, The Existence of God , Richard Swinburne argues that the world as we find it is one that a good and omnipotent God would have good reason to bring about. He does not claim to demonstrate, that is, deductively to prove, that the world is God–made but rather to show that the proposition that God exists and made the world is more likely to be true and hence more reasonable to believe, all things considered, than its (...) negation. He recognizes that in order to sustain this position he has to justify the existence of evil, especially natural evil, or at least to reconcile both the existence and enormous quantity of such evil with the claim that God exists. In fact, however, Swinburne aims beyond mere reconciliation to the point that the existence and nature of the world confirm the claim that God made it. (shrink)

Hume viewed religion as a way to relieve the anxiety caused by our fate, but as he saw it, the natural development of different monotheisms and religions often ...

The American Journal of Bioethics, Volume 12, Issue 7, Page 30-31, July 2012.

Fyodor Dostoevsky understood this practical dimension well, and it is embodied in his literary treatment of the problem of evil in his masterpiece, The Brothers' Karamazov.1 In what follows, I will interpret the powerful existential repudiation of Christianity based on the facts of human suffering voiced by the antagonist, Ivan. After noting some similarities of Ivan’s case to that given by the French existentialist philosopher Albert Camus in his novel, The Plague, I then turn to Dostoevsky’s response, expressed through the (...) final discourse of the Elder Zossima. My goal here is solely to interpret and to set in a clearer focus the way Dostoevsky approaches the problem of evil. At the end, I briefly note some outstanding issues facing his strategy for resolving it. (shrink)

This article discusses the place of sedation in the care of the terminally ill, as used in the practice of palliative care using case studies, clinical pragmatism forms the theoretical framework from which to elucidate the varying part that sedation plays in the overall management of a person facing the end of life. We contend that when used appropriately, sedation is an ethical and legitimate intervention that enhances comfort at the end of life and ought not sedate the person onto (...) “oblivion”. (shrink)

A lengthy argument for the existence of a being possessing most of the attributes ascribed to God in traditional philosophical theology is set forth by John Duns Scotus in the final two chapters of his Tractatus De Primo Principio.1 In 3.1-19, Scotus tries to establish the core of his proof, viz., that "an absolutely first effective is actually existent." It is an ingenious blend of elements that figure in standard versions of the cosmological and ontological arguments. However, while the reader (...) of De Primo is apt to be deeply intrigued by the suggestiveness and originality of Scotus' discussion, attempting to organize and interpret the various threads of argument is a challenging task. This no doubt partially explains the relative neglect of Scotus' argument in contemporary discussion of theistic proofs. In what follows, I offer a reading of the argument as well as my critical assessment of it. I will contend that Scotus is unable to achieve all that he wants, in that a critical aspect of his official version of the argument is centrally flawed. However, the text also seems to suggest a modified version of the proof which relies on intuitive support for a possibility claim. I maintain that this form of the proof is sound. Furthermore, owing to the comparative weakness of its underived premises, Scotus' proof can be seen to offer a novel and appealing alternative to the more widely advertised versions of the cosmological and ontological arguments. If I am right, then, Scotus' De Primo has an important contribution to make to the contemporary discussion of an issue of perennial philosophical concern. (shrink)

According to classical theism, contingent beings find the ultimate explanation for their existence in a maximally perfect, necessary being who transcends the natural world and wills its acts in accordance with reasons. I contend that if this thesis is true, it is likely that contingent reality is vastly greater than what current scientific theory or even speculation fancies. After considering the implications of this contention for the extent of divine freedom, I go on to discuss its relevance to the problem (...) of evil as an obstacle to rational theistic belief. (shrink)

The belief in progress is now seen as the naïveté of those who really did not know, or want to know, how terrible we human beings can be. We regard ourselves as somewhat wiser and more honest about the self-destructive capabilities of human beings and can find only reasons to turn away from the idea of progress.

In many ways, this is a difficult and important book about a difficult and important book about a difficult and important book. It is also much more, as Diamond highlights Anscombe's work on ethics and action as she moves to engage metaethical questions about relativism and truth. One of the unifying threads is the matter of thinking about thinking, especially the ways we respond to thinking that has gone astray. Thinking that does go astray traverses paths with "dangerous spots," as (...) Wittgenstein says. The dangerous spots may be muddles and confusions. To avoid these paths, we need sign posts. Diamond's work provides a... (shrink)

In many ways, the struggle for gay and lesbian rights has come of age, and mainstream politics in the USA shows signs of embracing the votes and monetary contributions of organized gay and lesbian constituents. But the author warns that a movement for sexual liberation pays too high a price when it mimics a conservative language of “family values.” Since the framework of “family” language is implicated in structures of heteronormativity and patriarchy, sexual liberation that plays the “family language” game (...) will be drawn into a narrowing politics of nondiscrimination. Furthermore, argues the author, the right to marry cannot be considered a human right, since it is always bound to local statutes and custom. Therefore, gay and lesbian liberation that seeks truly universalizable principles will do better to not ensnare its struggle in “family values.”. (shrink)